Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome is one of the most common hand conditions. It is caused by pressure on the median nerve in the carpal tunnel of the wrist. The carpal tunnel is an opening in your wrist that is formed by the carpal bones on the bottom of the wrist and the transverse carpal ligament across the top of the wrist. The median nerve provides sensory and motor functions to the thumb and 3 middle fingers. If it gets compressed or irritated, you may have symptoms such as numbness, tingling and weakness in the thumb and fingers.

Carpal tunnel syndrome occurs when the median nerve, which runs through the carpal tunnel in the wrist, becomes compressed. Swelling or pressure in the carpal tunnel can irritate the nerve, leading to the characteristic symptoms.

The main symptoms of carpal tunnel syndrome usually start gradually and include:

• Numbness and Tingling: You may feel tingling or “pins and needles”. Symptoms typically affect the thumb, index, middle, and ring fingers, but not the little finger. Numbness can become more constant and occur during the day, especially during activities that involve repetitive wrist movements. Numbness and tingling can often wake you up at night, prompting you to shake your hand to relieve the feeling. Holding objects like a glass, phone or book can worsen the symptoms.
• Muscle Weakness: As the condition worsens, you may experience muscle weakness in the thumb and hand, leading to dropping objects.
• Pain: The final symptom of carpal tunnel syndrome is pain in the area of the first three fingers and the wrist, which significantly limits hand use.

You should visit a doctor for carpal tunnel syndrome if your symptoms—such as tingling, numbness, or weakness in the hand and fingers—last more than a month, interfere with daily activities and sleep, or are not improving with home treatment.

Prompt medical attention is crucial because untreated carpal tunnel syndrome can lead to permanent nerve and muscle damage in the hand and wrist.

Any pressure or irritation on the median nerve within the narrow carpal tunnel at the wrist can lead to symptoms of Carpal Tunnel Syndrome (CTS).

The most common causes and risk factors for developing carpal tunnel syndrome are the following:

• • Anatomical Factors: A narrower carpal tunnel, often seen in women, and changes to the wrist bones from a fracture or dislocation, as well as arthritis, all reduce the available space for the median nerve,increasing pressure and leading to the condition.  
  • Gender: Carpal tunnel syndrome is more common in women, partly due to their generally narrower carpal tunnels.
  • Inflammatory Conditions: Conditions like rheumatoid arthritis can cause swelling and inflammation of the tissues around the median nerve, increasing pressure.
  • Metabolic Factors:
    • Obesity: Increased body weight is linked to a higher risk.
    • Diabetes: Diabetes can damage nerves, including the median nerve.
    • Hormonal Changes: Women during menopause or pregnancy are at a higher risk.
    • Thyroid Disorders: Hypothyroidism is a known risk factor.

• • Repetitive Activities:
    • Occupations: Jobs such as manufacturing industry workers are often at risk.
    • Hobbies: Playing musical instruments and other activities requiring repeated hand and finger motions can also contribute to increased risk.

The typical diagnostic process for carpal tunnel syndrome (CTS) involves a physical examination and electrodiagnostic tests like nerve conduction studies (NCS) and electromyography (EMG) of the median nerve to confirm the diagnosis. During the physical exam, doctor looks for characteristic symptoms, such as numbness in the first three fingers, and may use specific tests to check nerve function. Electrodiagnostic tests then provide objective evidence of median nerve compression by evaluating how electrical signals are transmitted and how muscles respond.

While conservative treatments like splinting and corticosteroid injections can help in the early, mild stages of carpal tunnel syndrome, surgery is generally recommended for severe symptoms or when conservative measures fail.

Carpal tunnel release surgery involves cutting the transverse carpal ligament, the ligament that forms the roof of the carpal tunnel, to relieve pressure on the median nerve. The surgery lasts about 15 minutes and is typically performed under local anesthesia or mild sedation. The surgeon makes a small incision (about 2 cm) in the palm, near the wrist. Special microsurgical instruments are used to open the tunnel and free the median nerve. The surgery is performed on an outpatient basis, meaning no hospital admission is required. Patients can usually return to their normal, daily activities within about two weeks after the surgery.

How much does carpal tunnel syndrome (CTS) surgery cost? 

The cost of CTS surgery is quite affordable. For more details about the cost and the procedure or any other questions you may have, please do not hesitate to contact us.

How important is physical therapy for the treatment of carpal tunnel syndrome (CTS)?

Physical therapy for carpal tunnel syndrome is particularly important, as it speeds up recovery and rehabilitation time. It includes the following stages:

• Massage: Soft tissue mobilization helps to relieve tension and improve circulation in the affected area.
• Joint Mobilization: Gentle movements are used to restore range of motion and reduce stiffness in the wrist and hand.
• Electrotherapy
• Flexibility and Strengthening Exercises: A tailored exercise program focuses on stretching the affected tendons and nerves and strengthening the surrounding muscles to support the wrist and hand.

Is there any alternative treatment for carpal tunnel syndrome (CTS)?

While various conservative treatments like ice / heat therapy, splinting, and yoga may temporarily reduce symptoms of carpal tunnel syndrome (CTS), surgical intervention is often considered the only definitively effective long-term treatment for severe or persistent cases.